Australian and New Zealand Intensive Care Research Center, Monash University, Melbourne, Victoria, Australia.

3

Medical Research Institute of New Zealand, Wellington, New Zealand.

4

Medical Research Institute of New Zealand, Wellington, New Zealand4Department of Intensive Care Medicine, Christchurch Hospital, Christchurch, New Zealand.

5

Medical Research Institute of New Zealand, Wellington, New Zealand3Australian and New Zealand Intensive Care Research Center, Monash University, Melbourne, Victoria, Australia5Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zea.

6

Medical Research Institute of New Zealand, Wellington, New Zealand3Australian and New Zealand Intensive Care Research Center, Monash University, Melbourne, Victoria, Australia6Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckla.

Erratum in

Abstract

IMPORTANCE:

Saline (0.9% sodium chloride) is the most commonly administered intravenous fluid; however, its use may be associated with acute kidney injury (AKI) and increased mortality.

OBJECTIVE:

To determine the effect of a buffered crystalloid compared with saline on renal complications in patients admitted to the intensive care unit (ICU).

DESIGN AND SETTING:

Double-blind, cluster randomized, double-crossover trial conducted in 4 ICUs in New Zealand from April 2014 through October 2014. Three ICUs were general medical and surgical ICUs; 1 ICU had a predominance of cardiothoracic and vascular surgical patients.

INTERVENTIONS:

Participating ICUs were assigned a masked study fluid, either saline or a buffered crystalloid, for alternating 7-week treatment blocks. Two ICUs commenced using 1 fluid and the other 2 commenced using the alternative fluid. Two crossovers occurred so that each ICU used each fluid twice over the 28 weeks of the study. The treating clinician determined the rate and frequency of fluid administration.

MAIN OUTCOMES AND MEASURES:

The primary outcome was proportion of patients with AKI (defined as a rise in serum creatinine level of at least 2-fold or a serum creatinine level of ≥3.96 mg/dL with an increase of ≥0.5 mg/dL); main secondary outcomes were incidence of RRT use and in-hospital mortality.

RESULTS:

In the buffered crystalloid group, 102 of 1067 patients (9.6%) developed AKI within 90 days after enrollment compared with 94 of 1025 patients (9.2%) in the saline group (absolute difference, 0.4% [95% CI, -2.1% to 2.9%]; relative risk [RR], 1.04 [95% CI, 0.80 to 1.36]; P = .77). In the buffered crystalloid group, RRT was used in 38 of 1152 patients (3.3%) compared with 38 of 1110 patients (3.4%) in the saline group (absolute difference, -0.1% [95% CI, -1.6% to 1.4%]; RR, 0.96 [95% CI, 0.62 to 1.50]; P = .91). Overall, 87 of 1152 patients (7.6%) in the buffered crystalloid group and 95 of 1110 patients (8.6%) in the saline group died in the hospital (absolute difference, -1.0% [95% CI, -3.3% to 1.2%]; RR, 0.88 [95% CI, 0.67 to 1.17]; P = .40).

CONCLUSIONS AND RELEVANCE:

Among patients receiving crystalloid fluid therapy in the ICU, use of a buffered crystalloid compared with saline did not reduce the risk of AKI. Further large randomized clinical trials are needed to assess efficacy in higher-risk populations and to measure clinical outcomes such as mortality.